Public Health

Reasons to shoo away the humbuggers

It's been a Scrooge of a year, wouldn't you say? Ebenezer Scrooge - whom I caught on television the other night looking a lot like the actor George C. Scott - was a man who refused to share any of his wealth with the world around him. The year 2012 bears a resemblance.

This year, we endured a divisive battle for the presidency, which was fought at times as though the only thing that mattered was how much money either side could raise. That's a sad statement for a country that stands for democracy.

Thousands were wiped out financially and emotionally by superstorm Sandy. Many innocents were lost to deranged gunmen in Aurora, Colo., and Newtown, Conn.

The economy refused to rebound, and Washington wouldn't come to agreement over anything.

And so the year 2012 was stingy like Scrooge. But in "A Christmas Carol," Charles Dickens thankfully gives us examples of two people who don't lose faith in the old miser: his long-suffering clerk Bob Cratchit and his nephew, Fred.

Cratchit raises a glass to Scrooge over the family's meager Christmas dinner - and over Mrs. Cratchit's objections. And Fred continues to invite his uncle to dine, year after year, even though the old man riddles him with insults.

We all know the end of the story. After his ghostly visitations, Scrooge accepts dinner with Fred and becomes a generous benefactor to the Cratchits. And so, neither should we close our hearts to hope for the 21st century.

Taking a wide look around, here are a few silver linings that emerged in 2012.

*Apple announced that it is bringing back some of its manufacturing to the United States. In interviews, Apple's chief executive, Tim Cook, said the company would spend about $100 million on U.S. manufacturing operations in 2013.

*Several cities, including New York, are reporting declines in childhood obesity - perhaps showing that public health campaigns can be effective. Obesity is a significant factor in health care costs.

*The years-long deployment of soldiers to Iraq and Afghanistan resulted in an unexpected gain for quality child care in this country. When parents began shipping out, the Department of Defense realized that there weren't enough approved, private child care slots. So the military worked with a national organization, Child Care Aware, to train and certify child care providers, greatly expanding the supply of quality programs.

*Here's another unexpected gain. During the economic downturn that began in 2008, even as people are hurting financially, they are demonstrating more compassion. The Corporation for National and Community Service reports a rise in volunteerism - exactly the opposite of what happened during hard economic times in the past.

There are many more bright spots; we see them in our personal lives every day. Let's hold a hope in our hearts for rebirth in our public life as well.

This essay was first published in Newsday.

Individualism vs. collectivism is a false choice

Hurricane Sandy

Hurricane Sandy

Some people say the 2012 presidential race was a contest between worldviews. On one side is the collective view (represented by President Barack Obama), and on the other, the idea that the individual succeeds on his or her own (promoted by Mitt Romney).

Think of the sound bites we had on these themes - from Rep. Paul Ryan's admiration for ultra-individualist Ayn Rand to Obama's reminder that business people didn't "build that" by themselves. They had a country behind them.

Superstorm Sandy, as if on cue, blew in to provide us with daily reminders of how we need each other. Driving past a recently bisected tree that had been blocking my daily commute, I know: I didn't cut that.

Neighbors have been checking on one another's well-being. Even in the heat of the close presidential contest, leaders of opposite parties returned to civility. Perhaps New Jersey Gov. Chris Christie, a Republican who considered challenging Obama, understood that he might need the White House - whether it's inhabited by an R or a D.

In "The Social Conquest of Earth," published earlier this year, naturalist Edward O. Wilson argues that humans evolved as we did precisely because we have strains of both individualism and collectivism. Wilson, who has spent years studying ant colonies, updates the idea that the fittest individuals survive. In fact, groups in which individuals sacrifice for the good of the collective have, over millions of years, won out. "Selfish individuals beat altruistic individuals," Wilson writes, "while groups of altruists beat groups of selfish individuals."

Groups that are willing to share, to withhold individual rewards in order to further the growth of the collective, emerged from the evolutionary contest to become modern humans.

But we've retained characteristics of both, Wilson says. We are forever stuck in between selfishness and generosity. If we were all-out collectivists, we would cooperate robotically, like ants. As extreme individualists, humans wouldn't have formed societies where we specialize in healing, finding food and building shelters.

It's that tension of being stuck in between that played out in the presidential election - and will continue to bedevil us. What's the right place on the spectrum? Does it change after a hurricane?

Individualists say that when people are free to act in their own self-interest, society benefits. This philosophy promotes hard work and worries about creeping totalitarianism.

Collectivists point out the many things we accomplish together that we wouldn't do singly - efforts that spread the cost over many people and even many generations: medicine, the university system, roads and airports, our judicial system, arming a military, fighting fires.

People who hold the collectivist view fear that job creators want an excuse for greed and special tax treatment.

The great thing is that we don't have to choose between these views - no matter what you heard on the presidential campaign trail. Science argues for some of each.

So, what's it to be to lift us out of the Great Recession? Other catastrophes, like the Great Depression, have catalyzed collective solutions. We emerged with the Social Security Act and the GI Bill and a sense that we're in this together.

It's been difficult over the past several months to feel a sense of fellowship, however. I purposely didn't vote for either candidate in my Assembly district yesterday because I thought they made false, destructive claims about each other.

So, I'm glad it's the day after Election Day. Let's set aside fake choices and use all of our abilities to move on.

This essay was first published in Newsday.

What's up with the U.S.'s declining birth rate?

End-of-the-world scenarios have been circulating forever. Some think the world will end with the Mayan calendar later this year. But I believe I've seen the real doomsday. Our species will simply fail to reproduce.

That's my conclusion from two news items. The first is from the U.S. Census Bureau, which announced a baby "bust" last fall. The census shows that, in 95 percent of counties across the United States, the share of the population younger than 18 was smaller than in 2000.

There are now more households with dogs than children.

The other piece of evidence is a book published this month from feminist author and blogger Jessica Valenti: "Why Have Kids?" A new mother herself at 33, she looks at the unhappiness among parents with young children and asks this very relevant question: Why do it?

According to interviews, Valenti concludes that it's the chasm between the idealized parental life and reality that causes so much woe. Americans glorify the mother alone at home raising kids.

It may be tempting to tut-tut Valenti and tell her that she'll get used to the lack of adult conversation and the jobs that require either 24/7 commitment or unemployment, with nothing in between. But her perspective may well spring not so much from her phase of life as from our time in history. Or, as we've begun to say about this economy that refuses to improve, her complaint is the new normal.

Raising children well has become increasingly difficult. I blame it on my generation - those of us who have teenagers, as I do, and older kids. Instead of banding together to wrest better policies from government and employers - or to create strong communities to assist one another - we've indulged ourselves in divisive "mommy wars." We have bickered about which is better, attachment parenting or free-range? Stay-at-home mothers or moms with paychecks? Opting out or having it all?

In 1996, we heard that it takes a village to raise a child, and we looked the other way.

Now, Americans are having fewer children. In 2007, according to the census, the average number of births per American woman was 2.1. That's just enough to hold the population steady. Last year, however, the birthrate fell to 1.9, the lowest in decades.

Have we decided that it's too difficult to go on - at least in the United States? France is still reporting somewhat higher birthrates. Perhaps the French crèche system of universal day care - which, by the way, supports an employment rate of 80 percent among French mothers - has a lot to do with providing young families with the resources they need to feel happy and hopeful enough to keep having children.

The reasons for the decreasing U.S. birthrate are many. The financial crisis of 2008 made parents fearful of another bill. The annual cost of center-based day care for an infant in 35 states - New York among them - is higher than a year's in-state tuition and fees at a four-year public college.

Wages have been falling for 40 years, which means that many household budgets require two, three or more jobs. Forget about quality family time with that schedule. One New Jersey town recently hired soccer coaches because it could no longer count on parents having the leisure to volunteer. Not only will we have fewer kids in the future, it looks like we can forget about fielding a team for the World Cup!

We could reverse these trends, if we believed that saving the species were important enough. We could fight for better policies. Or we could accept the situation and look on the bright side: It will be a lot easier to navigate store aisles without all those annoying baby strollers.

This essay was first published in Newsday.

Is marriage becoming extinct?

As poverty grows and the gap between rich and poor widens, there's a narrative developing that women may have taken this equality stuff too far.

Today, 41 percent of births in the United States occur outside of marriage, compared with 17 percent in the 1980s. The decline in marriage leaves parents - mostly mothers - to struggle alone financially. Depending on which study you read, sociologists believe that single parenting accounts for 15 to 40 percent of a family's likelihood of living in poverty.

Even Isabel Sawhill, who directs the Center on Children and Families for the moderately liberal Brookings Institution, wrote in May that former Vice President Dan Quayle was right 20 years ago about Murphy Brown: Unmarried motherhood is a bad choice. Children who grow up poor more often act up in class, become teenage parents and drop out of high school.

But this narrative implies that the rise of women's rights is to blame for all these changes - or that it is reversible. The bad news story also ignores the gains arising from the greater earning power of women, the looser divorce laws and the reduced social censure that have enabled so much single parenthood. The rate of domestic abuse has dropped steadily, for example, and women are less likely to commit suicide or be killed by an intimate partner.

Many single parents are raising wonderful children - I know several - but they don't have an easy job. We need to acknowledge that we are headed for a post-marital world, and adopt policies that will give the children of such families a better chance at a secure middle-class adulthood. Such policies will lighten the single parent's load, too, although that's no reason to oppose them.

First, we could educate teenage fathers about their responsibilities to their children. There's a lot of advice out there for girls but very little for guys. A man has the right to know whether he is the father, and to seek to be involved in raising the child. Men have a responsibility to provide financial support, and to see that decisions are being made in the child's best interest.

Counseling for couples planning to marry should be easily available. So many of us marry without a realistic view of how to live together. A handful of states - Florida, Maryland, Minnesota, Oklahoma, Tennessee - have passed legislation providing financial incentives for couples to participate in formal premarital education.

We must find other ways for kids to have more parental figures - if they can't have both biological parents - in their lives. For example, some builders have begun designing homes to accommodate multiple generations. Family rooms and dining rooms are larger, and the homes include two master bedrooms at opposite ends of the house, for privacy. Overall, the American housing market is trending toward smaller - but this home-sharing concept is part of the mix.

Living near extended family, having community centers and places of worship that attract all generations, extending the school day to accommodate extracurricular activities and homework help - these are also crucial.

If I hadn't met my husband and formed a traditional family, I may have had a child on my own. I was considering it in 1992, when the veep made his quip about Murphy Brown. Life's drive to recreate itself is very strong. That's something people don't mention often enough in these discussions.

If American marital norms are morphing into something we wouldn't have recognized 20 years ago, well, so be it. Let's take what good marriages have taught us about children's need for belonging and the influence of caring adults, and make sure we meet that need - no matter what forms our families take.

This essay was first published in Newsday.

Must the state drag parents into piercings?

iStock

iStock

The New York State Assembly passed a bill last week requiring parents to sign a consent form for their kids younger than 18 who want to have a body part pierced.

I don't normally react badly to nanny state imperatives; I don't miss the trans fats in my New York City restaurant meals one bit. But the body-piercing age limit struck me as intrusive.

It happens that the week before this bill passed, my 14-year-old told me she might like to pierce her upper ear or navel. Those seemed pretty tasteful to me, and more reversible than a tattoo.

"I suppose I should act shocked so you won't take your rebellion phase any further," I joked.

But this is serious. What right does the state have to insert itself into my job as a parent? Forcing my kids to ask permission would turn casual discussions about boundaries and style into high-stakes negotiations.

As a mother of teens, I see how important it is to them to develop their identities. And if everything they do to express themselves has to have a parental sanction - well, that's no longer self-expression, is it? At least, not a self-expression they are in charge of. It takes the freedom of choice out of the teen's hands and puts parents in the role of censor.

Would I be more concerned if my daughter wanted something awful, like nipple or genital piercing? Or an ear gauge? Absolutely. But then, she wouldn't be likely to talk to me about it. Let's face it, this bill could pretty much put an end to body piercings under age 18.

The bill is in the State Senate now, and it looks likely to pass before the scheduled adjournment on June 21. Legislators are under pressure after news stories in April revealed that kids as young as 12 were able to get body piercings for $20 in the East Village.

Some shops won't do the procedures on anyone who can't prove they're 18, and local laws in some places back them up. But there's no statewide minimum age, and if one parlor refuses to honor a young customer's wish, he or she can always shop around.

There is a certain logic in the body-piercing bill, since teens younger than 18 cannot get a tattoo, even with parental permission. The tattoo artist who breaks this law can fetch a class B misdemeanor, meaning a fine of up to $500 or as much as three months in jail. The body-piercing bill would carry the same penalties.

It's certainly hard to argue against parents being informed about body piercing, since it comes with health risks: allergic reactions, infections and scarring. Piercings can be easy to hide, but parents can watch for health problems if they know about them.

And piercing-shop owners may welcome the law. Who wants the legal liability for maiming or sickening a young client? They would probably be glad to be rid of the pressure to give a 12-year-old a tongue stud.

Katie Ragione at Tattoo Lou's in Selden says the shop already requires notarized parental permission for body piercing, and of those shops that don't, "we tell people to watch out for them." She's concerned that shops that cut parents out could be taking other shortcuts.

But it could also drive body piercing underground. Some piercers would still perform the work without parental permission, maybe at a far higher cost. Or, kids could simply grab a needle and an ice cube and do it themselves. If teenagers are determined to pierce something, they'll find a way.

Most other states have passed laws restricting body piercing for minors. Some Canadian provinces set the age at 16.

That lower age may just strike the right balance, and New York's legislators should consider that compromise. That would keep the younger kids out of the piercing parlors - and prevent the nanny state from treating older teens like babies.

Column first published in Newsday.

Mike Wallace left his mark on awareness of depression

iStock

iStock

Mike Wallace, the groundbreaking TV newsman who died Saturday at 93, worked hard at earning his tough-guy image. During some of the most volatile events of our times, he asked pointed questions of powerful people: members of the Nixon administration, cigarette manufacturers, the Ayatollah Khomeini, Louis Farrakhan, champions of the Vietnam War. He tossed aside his nervy image, though, to highlight a problem that many men have difficulty admitting: depression. This revelation by a highly visible tough guy has encouraged untold numbers to seek help.

Wallace spoke publicly about his depression for the first time during a "60 Minutes" retrospective of his career in 2006. He told the camera that he had tried to commit suicide.

Before Wallace went public, his doctor advised him against owning up to the illness. "'That's bad for your image,'" Wallace quoted his doctor as saying, in an interview with the Saturday Evening Post. "But finally, I had to face up to it."

Although it's more common for women to suffer from depression, men with this affliction more often end their lives, according to research published in the journal "Suicide" in 2008. Because families and the press are reluctant to make suicides public, it's not widely known that suicides are far more common in the United States than homicides - an estimated 30,000 to 35,000 each year.

The majority of men who kill themselves have not asked for help before their deaths, according to Ciaran Mulholland, a psychiatrist and international expert from Queens University in Belfast, Northern Ireland, whose findings hold for men all over the world. The reasons are poorly understood. Perhaps men are less likely to recognize that they are under stress or unhappy, Mulholland says, and more reluctant to consult their doctor about their distress.

Exacerbating the problem, health professionals are often less likely to consider a diagnosis of mental illness in men, Mulholland adds. This is true also for seniors, and especially African-American seniors, according to Charles Reynolds, a professor of psychiatry, neurology and neuroscience at the University of Pittsburgh School of Medicine.

Depression is hard to admit to. Even with everything we've learned about mental illness, it's often viewed as a moral or personal failing rather than as a medical problem. There's no blood test to show that someone is depressed, just a list of grim symptoms. Similarly, there's no clear understanding of what causes depression, just its risk factors: unemployment, social isolation, chronic illness.

Wallace was in his mid-60s when he plunged into a depression that put him in the hospital. He had been fighting a courtroom battle for his journalistic credibility, after being sued by Gen. William C. Westmoreland, who commanded the U.S. military in Vietnam from 1964 to 1968. Westmoreland alleged that he had been libeled by the Wallace documentary "The Uncounted Enemy: A Vietnam Deception," which claimed that U.S. leaders had deliberately underestimated enemy troop strength to prop up domestic support for the war. Westmoreland eventually dropped the suit.

In the midst of the trial, Wallace remembered, "I couldn't sleep, couldn't think straight, was losing weight, and my self-esteem was disappearing."

When Wallace spoke publicly about his depression, his message was that it is treatable - so much so that, at 88, he said the decades since he had begun taking antidepressants had been the best of his life. He lobbied for better health insurance coverage for mental illness.

When he embraced his depression, Wallace was motivated by a cause larger than himself. Just as he was in his journalism. This was one tough guy who could inspire us at our weakest.

Essay first published in Newsday.

Time for a 'living wage' for the middle class?

With millions out of work, complaints about the decline in middle-class wages may seem misplaced. But without some shoring up, the middle class will remain dispirited -- and our economy, which is 70 percent dependent on consumer spending, will remain in the dumper.

It may be that there's a role for government to play in buttressing these eroding wages, which result not only in a declining standard of living, but also in a family life so pressure-filled that it leads to its own problems: angry homes, fast-food diets, dependence on alcohol and drugs.

Calling for any sort of government role during these tea party times can raise charges of socialism. But the idea of a wage that supports some minimum standard of living -- shelter, clothing, food -- has been broached on and off for more than a century.

In the late 1800s, social activists began protesting wages earned by a working-class man that were not sufficient to sustain his family, without the additional wages of working children and mothers. The Catholic Church published a fundamental social teaching, "Rerum Novarum" (on capital and labor), that read, "Wealthy owners of the means of production and employers must never forget that both divine and human law forbid them to squeeze the poor and wretched for the sake of gain or to profit from the helplessness of others."

Shortly afterward, Australia's courts ruled that an employer must pay a wage that guaranteed a standard of living that was reasonable for "a human being in a civilized community" for a family of four to live in "frugal comfort."

In the United States, these ideas led to laws forbidding child labor, making education compulsory and protecting women from exploitive labor conditions. The campaign to establish a "family wage" was defeated, but in 1938, a lower standard, the federal minimum wage, was passed.

The Rev. Martin Luther King Jr., Daniel Patrick Moynihan and in 1968, a group of 1,200 economists including Paul Samuelson and John Kenneth Galbraith, have all supported some kind of minium income guarantee.

Echoes of this debate are being heard now, in the Vatican's critique last week of the global financial system, and in places where labor unions still have some sway: In the New York City Council, which at the urging of retail workers may require employers in commercial developments built with public subsidies to pay at least $10 an hour, a "living wage" higher than the minimum wage of $7.25; and in Albany, where the State Legislature in April passed an increase to $9 an hour for home health aides, who are represented by the influential 1199 SEIU United Health Care Workers East. That increase takes effect on Long Island in 2013.

It's easy to see why the lowest-paid workers would need a boost from someone powerful enough to argue on their behalf. But to make the argument for the middle class, one has to believe that this great swath of America, nearly half the country, has special value. And it does: The stability and upward mobility of the middle class not only underpin the U.S. economy but give America its famously optimistic and innovative spirit.

That spirit is on display as the middle class makes the best of things today: The average American has added around a month's worth of work, 164 hours per year, in the last two decades. One-third of American families have reduced their savings for college, according to a 2010 Sallie Mae/Gallup poll, and another 15 percent are not saving at all. Retirement savings are in similar decline.

How much more can the middle class cinch in its belt, before we lose what's precious about this way of life?

First published in Newsday.

Economic trends threaten families' health

After listening to President Barack Obama's job-creation address last week, I kept coming back to the idea that he wants to give payroll tax breaks to businesses that offer people pay raises. That struck me as odd, given that unemployment stands at 9.1 percent, and you'd think that this hard-times president would be focused exclusively on getting people back to work.

But even people with jobs are facing time and money pressures in this economy, pressures that are bad for families' health.

Certainly, putting cash in people's pockets should help to rev up the listless consumer economy. But it looks like the president is also acknowledging just how much wages have eroded in the last couple of decades.

Real wages have been declining since 1983 and that means the middle class has less buying power. At the same time, the average American has added around a month's worth of work -- 164 hours per year -- in the past two decades. The number of dual-income households has risen, as well as the number of people working multiple jobs. It's not hard to imagine that people are putting in more time at work to make up for the erosion in their wages. That sounds like a very busy -- an overly busy -- middle class.

This busyness has consequences for the mental and physical health of parents and children -- and study after study substantiates this. A six-year study of 11,540 working parents in France, published in 2007, showed that people who had higher work stress or greater family demands were more likely to miss work due to poor mental health, particularly depression. Research on working parents in New York's Erie County demonstrated a relationship between family-work conflict and depression, heavy alcohol consumption, poor physical health and high blood pressure.

Time pressures also contribute to weight problems. For the first time in history, there are more overweight than underweight adults worldwide, according to new research at American University. A study published in the January-February issue of the journal Child Development found that children's body mass index rose the more years their mothers worked over their lifetimes. One explanation offered is that working parents have limited time for grocery shopping and food preparation.

Not so long ago, as a society we were asking, is it better for families if parents stay home with kids or work outside the home? Moms were usually the parents in question. Now, because of steadily declining purchasing power, for most people, it's less a matter of choice than necessity.

I have to ask myself, was this a conscious decision? Did Americans choose "working parents" as the better alternative? Was it a good direction or have we lost something in the translation? Have we perhaps given too little thought to how parents can give both their employers and their children what they need?

The financial and time pressures on families are what make us so vulnerable to implied criticisms, like those on display in Amy Chua's "Battle Hymn of the Tiger Mother." It registered so strongly with American parents because we're insecure about having adequate resources to meet the challenges of raising children now.

It's too early to tell if the Obama tax break, if adopted, will be effective in raising people's wages, or even whether, if we made more money, we would choose to spend more time with our children. But it's worth trying to reverse some of the trends that are putting so much pressure on families' health.

First published in Newsday

Families of the mentally ill need stronger laws

It's obvious now that Jared Lee Loughner should have been stopped. In accounts by news organizations, his madness escalated so clearly: the classroom outburst about strapping bombs to babies, the government conspiracy talk, the eerie, miscued smiling.

But for those of us with a schizophrenic in the family, the progress can look a lot like a rebellious teenager dabbling in drugs and struggling to cross into manhood - not ideal, but in a word, normal.

People ask, why didn't Loughner's parents stop him? We may never know what other steps the family took - nor do we know whether the suspect is mentally ill, though he displays all the signs. But his father was alarmed enough to chase Jared into the desert - ultimately losing him - the morning of the shootings at the Safeway meet-and-greet in Tucson. To me, as the sister of a schizophrenic man, this is the quintessential family face of mental illness: chasing, and powerless.

Families, and other authorities, have too few tools for this disease that sickens men on average at 18 and women at 25. In Arizona, like more than half the states, in the absence of specific threats, it's impossible to force someone into treatment. The law requires that individuals constitute a danger to themselves or others. That means, in most cases, a suicide attempt or a crime. As we know from Tucson, waiting for such evidence can be fatal.

Since the 1970s, Americans have moved firmly away from forced treatment, horrified by stories of brutish conditions, lobotomies and traitorous relatives signing away a poor soul's freedom. But we have journeyed so far in the opposite direction, in our concern for the civil rights of the mentally ill, that they are too often going without the medical care they need.

Like other illnesses, this disease can worsen when left untreated. The consequences can be catastrophic.

Postponing help until after a crime has packed this country's jails and prisons with the mentally ill: The Treatment Advocacy Center, a national organization that wants stronger involuntary-treatment laws, estimates there are 280,000 mentally ill locked in correction facilities today, up from 170,000 a decade ago. These people are often not receiving the care they need to get well and live lives outside of a cell.

In September, Pima Community College, where Jared Loughner was enrolled, was sufficiently unnerved after several incidents that it sent two campus police to tell Loughner and his parents that he had been suspended - and those officers had backup waiting in the neighborhood, just in case. The school wanted him to be cleared by a mental health professional before he could return.

The school protected its students. But didn't college officials also have an obligation to the greater community? William Galston, who advised the Clinton administration on domestic policy, argued in The New Republic last week that college personnel, Loughner's parents and other adults should have been required to report his actions to the police and the courts.

One result, at least in New York, might have been a judge's order for a temporary commitment and medication. The threshhold here is "need for treatment," not just a person's likelihood of being dangerous. Nearly half use this standard, and 44 permit court-ordered medication. But the laws are rarely used. California, for example, recently passed Laura's Law but has not enforced it, lacking money and treatment resources, and fearful of violating patients' freedoms.

It's the nature of mental illness that nearly half of those suffering do not realize they are sick. That's why those of us around them need to give chase - and persist until we help them.

Originally published in Newsday

Child care choices persist into adolescence

Last month, a study about early child care came out with mixed results – one good for day care, and one bad. I decided to go back and take a look at how the news media covered the story. I have a bias: I think that we in the media reflect the American public's ongoing discomfort with the choices that dual-income families must make. Even though, at 46 percent of homes with children, dual-income households are becoming the norm. As I say, the study came up with good and bad findings. One of the biggest long-term projects of its kind, the University of California-Irvine study quizzed 15-year-olds who had been in day care as little ones. The study found that the teens who had attended "high-quality" day care did better in school than even those kids who stayed home. But the study also found that all day-care kids, regardless of the quality of care, were slightly more likely to take risks.

Is that a bad thing? Apparently, in teenagers it is. When we think of teens and risk, we think “drugs” and “sex.” Although, adult risk-takers, like inventors and money managers, are often highly compensated for such.

Anyway…. The results: My quick Nexis search turned up six neutral headlines, such as this one from States News Service, “Link between child care and academic achievement and behavior persists into adolescence.”

Five headlines gave a positive spin, like this from the Dayton Daily News: “Quality care in childhood pays off, study says.”

And seven headlines played up the negative. Here, from the Chicago Tribune, “Study: Day care kids show rash behavior as teens.”

I’m going to conclude that my bias at the outset was a little rash. This is fairly even-handed coverage – and good news for those of us who care about such things.

I also found the description of what constitutes high-quality child care to be illuminating, and cause for optimism. I remember looking for this description right after the study was published in mid-May, but I didn’t find anything this complete. I wonder if UCI updated it. No matter, here is study director Deborah Lowe Vandell’s take:

Q: How do you define a “high-quality” child care setting? ?A: It’s one where caregivers are warm, loving, sensitive, respectful and responsive to children’s needs. There should also be cognitive stimulation, with teachers talking and reading to children. If a child is wandering or getting into conflicts with other children, caregivers should find ways to intervene. If children are busy and engaged, however, caregivers should not interrupt or intrude.

What do you think? What's your observation about how child care affects kids? Does your child care measure up to this standard?

Out-of-work plastic surgeons a hazard

I've read that elective plastic surgery has taken a big hit during this recession, but I didn't realize that the surgeons have resorted to trolling for work in their old specialties. The problem is, they may no longer be as current as they should be. I have to have a haywire gland (a parathyroid) removed from my neck. The hospital directed me to their ear, nose and throat surgeon. But even as he was giving me the surgeon's name, the medical director said I might want to get a second opinion -- and he offered the name of a second ENT surgeon. I thought, "Whoa, that's weird."

So, I checked out the doctors on New York State's physician website, and I found that the first doctor described his practice entirely in terms of facial plastic surgery. He didn't even mention ENT work. So, I asked if he did the minimally invasive type of surgery I was looking for. He told me he did not, and then started talking on and on about the different types of scars. Again, a red flag went up for me. This guy was all about the surface.

I made some more calls and discovered that the second ENT surgeon doesn't accept my insurance. So, I ended up finding a third surgeon, one who has devoted himself to this kind of operation, both as a student and now in his specialty practice. I'm not very happy with the hospital staff who, essentially, threw me to my own resources. I'm sure there are rules and professional courtesies involved about who gets a referral, but I can't see where this process has the patient's best interests at heart.

Two days later, the first ENT called me to schedule the surgery. I told him that I had chosen someone else who offered the newer technique. For one thing, it means the difference between going under general anaesthesia or having a local pain blocker. "It's all marketing!" he practically shouted into the phone. When I argued with him, he offered to repeat what he had just explained to me, "but this time very slowly." Charming.

I have to think there was karma at work here.